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Radiation Oncology |
1 From the Departments of Radiation Oncology (M.A.C., P.A.K., J.H.S., M.B.), Thoracic Surgery (T.W.R.), and Hematology and Oncology (D.J.A.), Cleveland Clinic Foundation, 9500 Euclid Ave, Desk T-28, Cleveland, OH 44195. From the 1997 RSNA scientific assembly. Received September 22, 1998; revision requested November 4; revision received December 22; accepted March 8, 1999. Address reprint requests to P.A.K.
PURPOSE: To evaluate the usefulness of neoadjuvant chemotherapy and radiation therapy before esophagectomy for invasive cancer of the esophagus or gastroesophageal junction (GEJ).
MATERIALS AND METHODS: The authors conducted a retrospective analysis of 154 patients who underwent esophagectomy for invasive cancer between September 1, 1991, and December 31, 1995. The end points evaluated were overall, disease-free, local-regional relapse–free, and systemic relapse–free survival.
RESULTS: Seventy of the 154 patients received neoadjuvant combined-modality therapy (CMT) consisting of concurrent cisplatin and fluorouracil administration and accelerated, hyperfractionated radiation therapy. The remaining 84 patients underwent immediate esophagectomy. With a median follow-up of 34.7 months, the 3-year overall, disease-free, and distant metastatic relapse–free survival rates were 38.0%, 41.9%, and 56.0%, respectively. Although neoadjuvant therapy did not appear to prevent distant metastases, there was a dramatic effect on local control. After CMT, the 5-year local control rate was 90% compared to 64% after surgery (P < .001). Tumors in the GEJ recurred more frequently (P = .01); however, multivariate analysis showed CMT was the only independent predictor of local control. Postoperative mortality was 15.7% after CMT versus 5.9% without CMT (P = .05).
CONCLUSION: Local control of esophageal cancer is excellent following neoadjuvant chemotherapy and radiation therapy. However, the effects of CMT on overall and disease-free survival are less clear due to significant differences between the treatment groups.
Index terms: Chemotherapy, 71.1299 • Esophagus, neoplasms, 71.32 • Esophagus, surgery, 71.451 • Esophagus, therapeutic radiology, 71.1299 • Therapeutic radiology, preoperative, 71.1299
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